260025_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Inspec
n
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other /0 Denied Access
t-c
Date of Visit: Arrival Time: p aYv, Departure Time: Or County: J.U4 4Region:
Farm Name: 'g,Le,-I JC; - 2,_ Owner Email:
Owner Name: Rio (l 440/ Phone:
Mailing Address:
Physical Address:
Facility Contact:
N
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone: ,�/ �' /
Integrator: �L'�-yr �''ld' wa/
Certification Number:
Certification Number:
Longitude:
Finish
Design Current Design C►urrent
jiiIS Capacity Pop. Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dai Cow
Feeder
10
Non -La er
Dai Calf
o Finish
to Wean
Design Current
1] P,oult , C•a acl Po
La ers
Dai Heifer
D Cow
to Feeder
to Finish
E
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke Turke Poults
IMI 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes No
❑ Yes No
❑ Yes No
0
NA ❑ NE
NA ❑ NE
,® NA ❑ NE
❑ NA ❑ NE
[DNA ❑ NE
Page 1 of 3 21412015 Continued

Racili umber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? E] Yes ❑ No O NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
Y,
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift //❑ Application Outside of Approved Area
12. Crop Type(s): `Q'1 P l� Sf � ,) 1 7/`t • 6;-qa� ©wy
13. Soil Type(s): / 4_1<10 / 4K
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rM No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
`P No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility. umber: Date of Inspection: qlltl
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 'F No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[:]Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Phone: 4'0.. t44
' 3 349
Date:J.h Y.,h
21412015

VA5 %b) a I // qw-
Q Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
"� 0 Other Agency
Type of Visit: GeCompliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: @<Outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Coun dh74�. gion:
Farm Name: Owner Email:
Owner Name:(,t'-f� �, Phone:
Mailing Address:
Physical Address:
Facility Contact: OTitle: Phone:
Onsite Representative: Integrator: • _Z;f,
Certified Operator:Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[]Yes fo ❑NA ❑NE
❑ Yes
[] No
&?110A
❑ NE
[—]Yes
[—]No
P A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes E2rro
❑ Yes 00<0
ET A
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: (,�
Waste Collection & Treatment
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
r31VO ❑ NA ❑ NE
❑ No g? ❑ NE
Struc�tu�re�l � Structure
7 2 Structure 3 Structure 4Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):`
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
eqq
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2 o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[{<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
g2o1Pb
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Lam` 0o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Poleo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E31I10
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
c,
12. Crop Type(s): op 04
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L 10
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1 10
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
g?lo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
E�4
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
520K
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
5; o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
FL-Ao
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
G;XA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes [�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L]-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No ❑ NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 24o ❑ NA ❑ NE
❑ Yes 134o ❑ NA ❑ NE
❑Yes MKo ❑NA ❑NE
❑ Yes �o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes I(4eo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 020110 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [iOlo ❑ NA ❑ NE
Comments (refer to question #); Explain any YES: answers and/or- any additional recommendations or?any other comments ;ram. �4
Use drawings of facility. to better explain situations (use additional pales as necessary):"
6&P4 Aeff.
P� �..e�.eo= .lie. mpa•:�p �,... 46,
Reviewer/Inspector Name:
Reviewer/Inspector Si
Page 3 of 3
Phone: 7 JM',5_37
Date:(
IV2 1

?�Pqs
121 / zo /o
Type of Visit (5-Co—mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S iZpr 0 Arrival Time: : �O// Departure Time: /O .' Z j' County: Co•k �+ Region:
Farm Name: 1ti',Lye_y V t e-to 15a ✓>.ti Owner Email:
Owner Name: uSSe,// l Pd I Phone:
Mailing Address:
Physical Address:
Facility Contact: (516�0 We—Af- y _T Title: 5/2p G. Phone No:
Onsite Representative: Integrator: = Ad
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: = e
Operator Certification Number:
Back-up Certification Number:
Longitude: ❑ o ❑ ' =
Qesign Current
Design Current Qesign Current
Swine Capacity Population
Wct Poultry Capacity Population Cattle C«apaeity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
IEJ Non -Layer
I ❑ Daia Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Dry Poul ry ❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers El Beef Feeder
❑ Pullets
❑ Turkeys ❑Beef Brood Cow
❑ Boars
Other
❑ Turkey Poults
❑ Other Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NE
ElYes
ElNo
,LS-NA
LAVA
❑ NE
LTNA
El NE
❑ Yes
No
ElL"1Yes
E❑
<o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number:2 2— Date of Inspection = -/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No NA El NE
a. If yes, is waste level into the structural freeboard? ❑ Yes:No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 J .3 2, 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ E Yes ivo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2 o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes B<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes To ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes to ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s) E"V`k L A,P4S u S dGf L O rs
13. Soil type(s) U ire 1,,J
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
ErNo ❑ NA ❑ NE
No ❑ NA ❑ NE
L" NNoo ❑ NA El NE
_,i
L+�'No ❑ NA ❑ NE
Blo ❑ NA ❑ NE
Comment '(refer to question #). Explain any YES answers and/or any recommendations or any other comments x x ¢�
F ,
Use drawings of facility to better explain situations. (use additional pages'as necessary):
7
Reviewer/Inspector Name I �j Y
Phone: ln/O,$W-3300
�'
Reviewer/Inspector Signature:
Date: S -ZS" ZD/D
12128104 Continued

Facility Number:2 —Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes MNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 7N9
< ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes M N ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes L� N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes LI No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�,�
ETNo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
OTNo ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E2 o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
SNo ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2'No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Io ❑ NA
❑ NE
Aitditional Caitlin nts ndlor Dw gs:
•
12128104

-rAfS
//-13 - zoo 9
Type of Visit ompliance Inspection O Operation Revlew O Structure Evaluation Q Technical Assistance
I_'
Reason for Visit 9"Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: O: !, County: 64'1414, iRegion:
Farm Name: i tUG✓ !� r.L�J i cZi':�r Owner Email:
Owner Name:-1,sl_5'c!'%z &/0Z Phone:
Mailing Address:
Physical Address:
, " 40
Facility Contact: _. G''rAQ le,,VV e L., Title: /e[el, z4ce. Phone No:
Onsite Representative: Integrator:
Certified Operator: �yrfe!� ��(/uor>j Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [_] o = ' = « Longitude: 0 0 = ' =
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
JE1 Layer
❑ DaiLy Cow
❑ Wean to Feeder
I
IEJ Non -Layer
I
I ❑ Daia Calf
❑ Feeder to Finish
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
® Farrow to Wean .5 o
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
ElTurkey Points
El Other Number of Structures:
❑ Other
Discharges & Stream Imuacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑Yes [I No M- A El NE
❑ Yes
❑ No E NA
❑ NE
❑ No E NA
❑ NE
❑ Yes
❑ Yes
No ❑ NA
❑ NE
❑ Yes
�!N`o[__] NA
❑ NE
12128104 Continued

i
Facility Number: 2 & - 2 $ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes fo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes vo _❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4? tU Ly
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
9<o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
BNO ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[5 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑-55' ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
214o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application`? If yes, check the appropriate box below. El Yes
,--, ,�
Lt -ITo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �zyi�ru rrr... �/+�, F jizg/r�� _r trl� d.��, �y l0. s•�
13. Soil type(s) Zet. Ke-la,v cL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[-�
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,No
I_� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
['No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑'Kb'
❑ NA
❑ NE
Comments(refer to'question'#) Eaiplain an`y YESyanswers'and/or any,rectavommendations or any other comments.
Use drawings of facility, to better explaen situations (usc_acldtionalpage ary) 1
7, i / 7-at a — 4- -fed y - 2, e. I 15-4 ­► a .J omt a ce / • -7 f- e*e, AL-v a
LJ[i% s7.t/e/rf+'1 ?'W -C s�bwc 13 /i�tl-IV fp/ L7t�./ cr fsat CeNei .9- cxv i,ttJ!1'02)
Reviewer/Inspector Name ��' %,° . eaPhone: clIV, el
Reviewer/Inspector Signature: �2-44_, Date: h* /2 "2000
12128104 Continued

I
Facility Number: :Z& —Z Date of Inspection // /' - 0 y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes D<o ❑ NA ❑ NE
❑ Yes 0o _ ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
BNo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
.,,�❑
EE cvo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9-No- ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B-9-o ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9-56 ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9-3Po— ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
21g5 -❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes BLS ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ej 1qo""❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
['T'l o�❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
['-}'1To___❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
211o' ❑ NA
❑ NE
Additio a1�Comm n'ts and/.or D logs:
12128104
12128104

1z-zz-ZOO1
Bsxls
Type of Visit Gelfompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (ki outine 0 Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: /Z Z/-.99 Arrival Time: /: 3S Departure Time: .Z,O County: CtiwAe_o-Ael
Farm Name:-0a%1,go d 4ap- t Owner Email;
Owner Name: �i Ginna vdw �l�✓� Phone:
Mailing Address:
Region: 147X®
Physical Address:
Facility Contact: GY ecy- A00 e-.- Title: -T 1-4 4f C_C Phone No:
Onsite Representative: G r<-t-{/ l� +r-� Integrator: G44"XfAld /z: ScjAo/,-,
Certified Operator: �' �'� �a�� Operator Certification Number: 1 7B1L
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 o =' =" Longitude: = ° =' = "
Design C►urrent
Swine Capacity Population Wet Poultry
Design Current Design Current
Capacity Population C•AM Capacity Population
❑ Wean to Finish
❑ Layer I I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I I ❑ Dairy Calf
❑ Dairy Heifer
Dry Poultry ❑ D Cow
ElNon-Dai
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Pullets El Beef Feeder
❑ Beef Brood Cow
❑ Turkeys
❑ Turkey Po Its
❑ Other Number of Structures:
Feeder to Finish 1 / 7 /
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharnes & Stream impacts
"No
1. Is any discharge observed from any part of the operation?
❑ Yes
El
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[T] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
D A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
3<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2Io
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: ;2& —3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [--]Yes ,B o El NA El NE
a. If yes, is waste level into the structural freeboard? ❑ Yes L_�fNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z6*=
Spillway?: NO
Designed Freeboard (in): 147
Observed Freeboard (in): 2— Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
3<
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
3<o
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes
0
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Bo
tvo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
,--��
8,
1vo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes •B
,��
1vo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[_ fo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) roki Sv ec �../l��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
21No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
13No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or we acre determination" ❑ Yes
'Co❑
NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9 t
[I NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
91gwo o
❑ NA
❑ NE
i•. � _ _ 4 _n,-io , :.;;,
5-4, Z. 4-e; 4rn d.4,4 at O,, -Z, zCo s
Reviewer/inspector Name C e V �.. U r; �a ',"xr{K
Phone: 9!d,3j • 3,3 D 0
a..�'
Reviewer/inspector Signature: Date: /Z-Z/—Z00%
12128104 Continued

Facility Number: fit: -3 9 Date of Inspection
Required Records & Documents �.,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 27No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9<o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑-Ko' ❑ NA' ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9<o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,_—i<oo�❑
l.� 'No ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
3-<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E !moo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
L`_ 1 o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,
i SIvo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
. to
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,-,
1..� o
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site'representative?
❑ Yes
[�w—
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
9t o ❑ NA
❑ NE
Additionai Comments and/or Drawings:
12128104

t3rus 9-0y- 08 kl
Type of Visit
Compliance Inspection
O Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral Q Emergency
O Other ❑ Denied Access
Date orvisit: ~ �7- 8 Arrival Time: Departure Time: �,' S~ County: e1144f4et_/4Ou51 Region: 11�®
Farm Name: f?r'✓e_ v- We id r rwt Owner Email:
Owner Name: �rlSSe%� CjlbdkD� Phone:
Mailing Address:
Physical Address:
Facility Contact: tSeNd tlIIifevNGc1 Title: �'�` " ' gp;P ' Phone No:
4.1
Onsite Representative:
Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 ❑ { ❑ Longitude: = ° = 1 ❑ 4I
Desig61
n
Cal; sty
Current
PPRp l tiu
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Daity Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non-Dai
❑ La ers
El Beef Stocker
Non-Laers
El Pullets ❑Beef Feeder
❑ Beef Brood Cow
❑ Turke s
❑ Turkey Poults
❑ Other Number of Structures:
Eff Farrow to Wean
❑ Farrow to Feeder
,j D
❑ Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
0
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[3'*No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
BNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
3<A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
--Lj
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
lA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
3 o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑-115'
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Date of Inspection
Facility Number: Z — Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
3<0 ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: Lcr �j 2-
Spillway?: 4 '0 Wo
Designed Freeboard (in):
Observed Freeboard (in): 'yo -3Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Lf No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0'qo— ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �.��
9. Does any part of the waste management system other than the waste structures require ElL7 Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 16% or 10 lbs ❑ Total Phosphorus ❑ Failure,to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) .Z:5e_V lees— //y�z-,% n�i��t _ ) . gm,,
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,..�,�
l_s No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
j31qo'
❑ NA
❑ NE
17,
Does the facility lack adequate acreage for land application?
❑ Yes
�lo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0<o
❑ NA
❑ NE
ReviewerAnspector Name f . ,E,_ 1 Phone: 9/ig.
Reviewer/Inspector Signature: Date:
RL P J IL/LA/V4 [.Vn[/R!(C(!
�J

y .
Facility Number: 241�1 — ?_S Date of Inspection 119 '47—
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElE Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes b !No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E, N��o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�0
oo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,L��,,
[3 o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Eklo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [3 o ❑ NA ❑ NE
Other Issues �,�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�
0 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
C3 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�,�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E ' o
❑ NA
❑ NE
Page 3 of 3 12128104

r
Facility Number 2 tp Z S
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency "
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S'L3-a% Arrival Time: /D,'gpq..� Departure Time: %l.y',W County: Region:
Farm Name: A+- 1444--A F�ky­,S ipyrWl A1411- Ak'J Owner Email:
Ns,J Owww
Owner Name: ,PusSe./ Ajmd ��d� +rl%r u^� Fa��^^ T''G. Phone:
Mailing Address:
Physical Address:
Facility Contact: &enjo ecN ue_C1h Title: II-e.GL. SP e,e_ • Phone No:
Onsite Representative: !�2 erNo Kemnjsdti___ _� Integrator: 7 -b Wt
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Q 6 Longitude: = ° =, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
!,S O
1 //i O D
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Cattle
Design Current;`,
Capacity Population"",
❑
Dairy Cow
❑
Daia Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes M No ❑ NA ❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
% No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
12128104 Continued

f Facility Number: Z& --Z$
Date of Inspection 15--�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes % No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes pi No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /_ Z
Spillway?: Al O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Qj No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ?No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) s I
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
�1
12. Crop type(s) tva dA_ (/#a=laael:5 � ) j S$PKi� 6e1iA S !//OVWSae-ci J
13.
Soil type(s) A&A La-d J
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/Inspector Name R,-ic Phone: 9/4. $�33. 3330
Reviewer/Inspector Signature: G..e��� Date: 5 23—Z00%
12128104 Continued

f Facility Number: Z(o — 2S Date of Inspection 5-23 -D7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certifieation?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
[P No
El NA
❑NE
❑ Yes
ip No
14 NA
❑ NE
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
11No
4 NA
❑ NE
❑ Yes
P No
❑ NA
[:1 NE
❑ Yes
P] No
❑ NA
❑ NE
❑ Yes
;fl No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
FA No
❑ NA
❑ NE
E
Page 3 of 3 12128104

I
r.
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: - Arrival Time:11211 Ir Departure Time: �' ),� County: Clt22b Region: s_�
Farm Name: I -or N,-e L _ rnti�5 Owner Email:
Owner Name: ti �I'' J en.� Phone:
Mailing Address:
Physical Address: I
Facility Contact: & VIfl o rrrn rep y Title:
Onsite Representative:r r� a __-•�rrr� �c� �i ^_
Certified Operator: 0u%s.n�
Phone No:
Integrator: 'M 0-
Operator Certification Number:
Back-up Operator: I Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ 4 = 11 Longitude: 0 ° ❑ 1 ❑
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
II ❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: ®�
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes rV No El NA [I NE
❑ Yes
f No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: iv — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes &No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2-No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
[4 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VkNo
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
12128104

Facility Number: (r—
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 7i
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): a t e.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes WNo ❑ NA FINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [Z No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
g.Ycs ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IZNo ❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[qNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
CzNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
,4".' 3x'+`TCR.� 'i t4w- , ,
Comments (refcrYto question!#) - Explain any?YES answersiandlor any recommendations any other commen s.
Usedra(wingsofifacilityYto bettereipfain `situations '(u`se aYdditional�pageas nc ssary):
GD�'t
{�.-i
7 Tn&44_ W Z) rk - r� 04 La.7Dp a*%13
Reviewer/Ins ector Name - — - t� ice Phone:
p ,_ r s 73
Reviewer/Inspector Signature: Date:
12128104 Continued

! ,,P; '. ?, � ''�S8'�A `: '' .i v. n w r.+ mt*:+L'z " 7. ,i' '.�y A;+s.{; •s.. grit'". r 1' ""y .`�., �4 h nT 'w i kf-, w ,,, �.!
cirq �� Di�*isian ofgWitterQnaltft}' t 2
:•� f d ��� �,�.yi
;�I � � !4i �i ��. i�:.4f � ssi I f (E i a's s -ay,,i i�r s.- �1�,`{`: a '1 - r'�� � u, „; s �. n } � -,� f s • - r
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Foci ih Number G Date of Visit. � Time:
Not Operational Q Below Threshold
® Permitted ® Certified 13 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: lie G►eci S re. r- to. ___ _ County : Gk►; ►�j eJ"LC�.r. 1�.� a
Owner Name: � 'r Q + zA^ r _ _ _ Phone No: _ 4r a A gM — _1 1) h e
Nlailinb Address: ���' � C•zci�.tl�r'lf ��n� &R- 8
Facility Contact: _ b�-_�,y-� C.r.c Title: Phone No:
Onsite Representative: (2_or4Fs integrator: 11)l`►rl _
Certified Operator: r l9i.rt..�.s- Operator Certification Number: 2.,D01
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a t " Longitude I
Design Current
Swine UR achy Population
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean I i n I r_aL I
IL I Farrow to Finish I I I
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I I ❑ Dairy
IQ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
(_J Gilts
❑ Boars I Total SSLW
INumber of Lagoons { I {❑_Subsurface_ Drains Present HLJ Lagoon area {❑ Sprati Fie1d Area `{
,Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Mang ement System
njsGharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes (No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes G No
Waste Collection Treatmew
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpiIlway ❑ Yes MNo
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure b
Identifier: I.
Freeboard (inches): AL 5
OM3101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes [�Vo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [@ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 23No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes RNo
12. Crop hype Qs° r w% I. A&_ ..C1,34 - GZ .O .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [SNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15• Does the receiving crop need improvement? ❑ Yes N No
16. Is there a lack of adequate waste application equipment? ❑ Yes allo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RINo
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
M•No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ELNO
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[RNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
R] No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
CRNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
UqNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[&No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1EINo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer two question #) Ezplaitt anff,ES'answers and/or any recomment�ativng„�r�any�athcr comments...:
Usctdrawirigs of facility.to better explain'situatiaas. (use additianalpage"s as ,necessary). ❑Field Copy ❑ Final Notes
�:v7s..
!/VS bs- 1Si,sr CV4
H
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 { 1 Continued

Facility Number: At, — ;k,5 hate of Inspection !d
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan bells, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No

Type of Visit: Compliance Inspection Operation Review Structure Evaluation O Technical Assistance
Reason for Visit: 10 Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: D ' (7 Departure Time: h9lt Countyi�i//7��FRegion: 40e
Farm Name: t�`►^Q.r^tJt ..1 Owner Email:
Owner Owner Name: RG(s( [�Lk7� Phone:
Mailing Address:
Physical Address:
Facility Contact: Cell v I&Wzk Title:
Onsite Representative: 11
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: �1—%7YF��✓1'�
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Cur,,e n tj
Wet Faultry Capacity Pop.
La er
Cattle
DailyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr, P,oult , Ca aci F,o
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Jeef Brood Cow
Boars
Othe
OtherI I IOther
Turke s
rkey Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑Yes MNo ❑NA ❑NE
❑ Yes [:]No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes []No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes [P No
PNA
❑ NE
DNA
❑NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Ficility Dumber: - J Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Struc Pure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
LI
Observed Freeboard (in): 70
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) F
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes Opo ❑ NA ❑ NE
❑ Excessive Ponding ❑Hydraulic Overload []Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs.] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acce table Cr p Window
� /❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Cql
13. Soil Type(s): .. &&W l4!
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fP No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
iT
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
t�TNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ep No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ElSoil Analysis ❑Waste Tra sfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

%acfliq Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes QD No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
Q9 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑Yes [�No ❑NA ❑NE
❑ Yes �@ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Expinin any YFr$ answers and/or any, addition al.recommendatlons or.,any other continents
Use drawings, of facility'fo better. explainjituations (use additionatpages as. necessary). .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/L9Cilf�� Phone:47%a %'5:"
Date; 9/1AI'&
21412015

fly
Rype of visit: 0 uompuance inspection V uperation xeview u ,tructure Evaivation V 1 ecnnical Assistance
eason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /2' S' Departure Time: p/�i,.,, County: k94W Region:?
Farm Name: II04.ry l�ea'j 1;1v� Owner Email:
Owner Name: PuSS.eL1 tie'ed Phone:
Mailing Address:
Physical Address:
Facility Contact: o !~ Title:
Onsite Representative:
Certified Operator: (42OU 11C W w
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: j/ I lTil
Certification Number:
Certification Number:
Longitude:
Design
Current Design Current
Design
Current
Swine CapacityWet
Poultry Capacity Pap.
Cattle
Capacity
Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D , P,ault , Ca acit P,o
Non-Daity
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
[�J NA
❑ NE
❑ Yes ❑ No
❑ Yes n No
❑ Yes MhNo
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facilaty umber: - 2 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
FZ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
IM NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 7/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tff No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[!R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
G9 No
0 NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wei stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste ARIllication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ea No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cro Window JJ�� n❑ Evidence of Wiin'd Drift ❑ Application Outside of Approved Area
12, Crop Type(s): r s 4"'�^�A C'., H"_) 1 7�- &-j' O'v�r�s��d�'
13. Soil Type(s): �1 Ltak --
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Ycs M No ❑ NA ❑ NE
LPU
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [5] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes M No ❑ NA ❑ NE
❑ Yes (5g No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ®No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA 0 NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [U No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

• Facility umber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
® No
!�
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes �3 No ❑ NA ❑ NE
❑ Yes ❑+No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss revicw/inspection with an on -site representative? ❑ Yes [P No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [P No ❑ NA ❑ NE
Comments (refer,to question #) Exp1hIn any;YES answers andlorfany additional fecommendations or any other comments "
Use drawlfigs of facility to better ezpliiin'situ'ations (use:additional'oage`s'as4we0ssaiW
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 110— 7
Date: Lw
21412014

Type of Visit: 0 Compliance Inspection U Operation Review p Structure Evaluation U Technical Assistance J
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access II
Date of Visit: Arrival Time: Departure Time: 0 County: qL" j egion:
Farm Name: Owner Email:
Owner Name: ise Phone:
Mailing Address:
Physical Address:
Facility Contact: C1� 42t�K ems, Title: Phone:
Onsite Representative: of Integrator: IR- /" KUc o %�' G
Certified Operator: Ru s�w A%0Z Certification Number: 2 Y % SZ
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude: -
De, ig urrent
Design
Current
Design Current
Swine
Capacity
Pop.
1�Vet Poultry
C►apacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
O
nr I;oult ,
Ga acl
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeX Poults
Other
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
3 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
l'
a. Was the conveyance man-made?
[:]Yes
[:]No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
[ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
T
Page 1 of 3 21412011 Continued

r
lFaciNty Number: - Z$ Ds ection: 17
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes KNo E�JNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes` No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [3Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN [3 PAN > 10% or 10 lbs, ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 1
w r ❑ Evidence of Wind,Drift E] Application Outside of Approved Area
12. Crop Type(s): C _*"""'` 6 l }-'ti (C 0 yoff ) 1 5;." 616L4 01-
13. Soil Type(s): La lee jo-el . -qt _ v r [ he
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes[
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ep No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [29 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IP No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

>l'atilf Npmber: - Date of Ins ection: Z f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [A No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box(es) below. TT
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [ff No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes ED No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EP No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ilb- _ 370
Date: 7h%q
2/4/1011

(Type of Visit: 0 Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I VIF!304% I Departure Time: �County: Region:
Farm Name: j4.,\P.rvifA,/ Fe"mS
Owner Email:
Owner Name: 'P-kS $t(l 0. ('i.qo d Phone:
Mailing Address:
Physical Address:
Facility Contact: Ge.�,oTitle: Phone:
Onsite Representative: Lt J integrator: -rDM %+„ S. �+r
Certified Operator: ZKSS.Q U Wood Certification Number: 2'
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Deslgn
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
[Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
r aI
bqtD
. P,oultr,
Ca aei
P■o
Non -Dairy
Farrow to Finish
La ens
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [�j NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Condnued

r ,
Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
' ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
P NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard Z,l'
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
P No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
IF
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
rCrop
�Window /❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): a"l -;k ri"� eNe[Ss I H a._ _Tel Sousa , �'o-. `'t— C)
13. Soil Type(s):' Laio lr (Q
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EP No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
Ep
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did.the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes b� No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

/ . .
Facility Number: jDate of Inspection: ?4 .3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [P No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1P No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ YesIr
No
❑ NA
❑ NE
❑ Yes
EP No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes ® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [p No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M",Pe Phone: —V33 202
11�_4wlll� Date: 7,9 LJ
214 011

(Type of Visit: {Compliance inspection Q Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: lwya Arrival Time: Departure Time: County: eumimrAn d Region: rn 0
Farm Name: ?13_U QR Vs?_w { ARV\S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: L►J Kenn E Title: `Tt_ C,, Uac. Phone:
Onsite Representative: 4 j%M£ Integrator: TOO) FARMS INC,
Certified Operator: [1u.r;�SE1� �..JC�a i3 - Certification Number: ig 14 is($
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
besign Current
Sapacity
Design
Current
Design Current
Swine
Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
415LO
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
Beef Brood Cow
MEN
i W AUY s
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes � No ❑ NA [3 NE
❑ Yes
❑ No
N NA
❑ NE
❑ Yes
❑ No
[Z NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [2 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: to - Date of Inspection: p
'�-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
L.CI No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
['� No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: # ] al
Spillway?:
Designed Freeboard (in): jC1 q
Observed Freeboard (in):� �L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[$] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [M No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [V No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �6 g,1Z v-f\UIDA (";,,-4
13. Soil Type(s): i.,,]Ai'1p Z) % A A Ik- --
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [50 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [7 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes [$] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

il
Facili Number: IDate of Inspection: a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Co No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes RU No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
'] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: L".� 10,0 1 ��
Page 3 of 3 21412011